<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Merchant')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-merchant" data-rule="required" class="form-control" step="0.01" name="row[merchant]" type="number" value="{$row.merchant|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Register')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-register" data-rule="required" class="form-control" step="0.01" name="row[register]" type="number" value="{$row.register|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Service')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-service" data-rule="required" class="form-control" step="0.01" name="row[service]" type="number" value="{$row.service|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Face')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-face" data-rule="required" class="form-control" step="0.01" name="row[face]" type="number" value="{$row.face|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Referral')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-referral" data-rule="required" class="form-control" step="0.01" name="row[referral]" type="number" value="{$row.referral|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Prescription')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-prescription" data-rule="required" class="form-control" step="0.01" name="row[prescription]" type="number" value="{$row.prescription|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Reward')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-reward" data-rule="required" class="form-control" step="0.01" name="row[reward]" type="number" value="{$row.reward|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Integal')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-integal" data-rule="required" class="form-control" name="row[integal]" type="number" value="{$row.integal|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Integal_1')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-integal_1" data-rule="required" class="form-control" name="row[integal_1]" type="number" value="{$row.integal_1|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Share')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-share" data-rule="required" class="form-control" name="row[share]" type="number" value="{$row.share|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Money')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-money" data-rule="required" class="form-control" step="0.01" name="row[money]" type="number" value="{$row.money|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Recharge')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-recharge" data-rule="required" class="form-control" step="0.01" name="row[recharge]" type="number" value="{$row.recharge|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Image')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div class="input-group">
                <input id="c-image" data-rule="required" class="form-control" size="50" name="row[image]" type="text" value="{$row.image|htmlentities}">
                <div class="input-group-addon no-border no-padding">
                    <span><button type="button" id="faupload-image" class="btn btn-danger faupload" data-input-id="c-image" data-mimetype="image/gif,image/jpeg,image/png,image/jpg,image/bmp" data-multiple="false" data-preview-id="p-image"><i class="fa fa-upload"></i> {:__('Upload')}</button></span>
                    <span><button type="button" id="fachoose-image" class="btn btn-primary fachoose" data-input-id="c-image" data-mimetype="image/*" data-multiple="false"><i class="fa fa-list"></i> {:__('Choose')}</button></span>
                </div>
                <span class="msg-box n-right" for="c-image"></span>
            </div>
            <ul class="row list-inline faupload-preview" id="p-image"></ul>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Back_hour')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-back_hour" data-rule="required" class="form-control" name="row[back_hour]" type="number" value="{$row.back_hour|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('User_hour')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-user_hour" data-rule="required" class="form-control" name="row[user_hour]" type="number" value="{$row.user_hour|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Consultation_hour')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-consultation_hour" class="form-control" name="row[consultation_hour]" type="number" value="{$row.consultation_hour|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Time')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-time" data-rule="required" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[time]" type="text" value="{:$row.time?datetime($row.time):''}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Interval')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-interval" data-rule="required" class="form-control" name="row[interval]" type="number" value="{$row.interval|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Chat_time')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-chat_time" data-rule="required" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[chat_time]" type="text" value="{:$row.chat_time?datetime($row.chat_time):''}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Consultation_fee')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-consultation_fee" data-rule="required" class="form-control" name="row[consultation_fee]" type="number" value="{$row.consultation_fee|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Txyappid')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-txyappid" class="form-control" name="row[txyappid]" type="text" value="{$row.txyappid|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Txyappsecret')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-txyappsecret" class="form-control" name="row[txyappsecret]" type="text" value="{$row.txyappsecret|htmlentities}">
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-success btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
